NAIROBI, Kenya, Sept 15 – The Social Health Authority (SHA) has flagged hospital claims worth more than Ksh3 billion, giving medical facilities just 15 days to provide missing documentation or risk automatic rejection of their submissions.
In a statement on Monday, SHA Chief Executive Officer Dr. Mercy Mwangangi explained that the flagged claims were identified during routine adjudication exercises. A majority were found to be incomplete, lacking critical documents such as itemised invoices, filed claim forms, and patient discharge summaries.
“As part of the routine claims adjudication exercise, SHA has flagged over 3 billion worth of claims that require more documentation to assist the review teams to adjudicate the claim,” the statement read.
New Resubmission System
Beginning September 16, SHA will roll out a Missing Documents Resubmission Module on its provider portal. This tool will allow hospitals to upload missing paperwork directly into the system, streamlining the correction process.
Each flagged claim will carry a 14-day countdown timer visible to providers, ensuring hospitals remain aware of the deadline. Importantly, the system will retain original documents already submitted, meaning providers will only be able to add missing files without altering previous entries.
Patients will also receive notifications when claims linked to them require additional documents, a move SHA says is aimed at enhancing transparency and accountability.
Strict Deadlines and Rejection Policy
Hospitals have until September 30 to comply. After this date, incomplete claims will be marked as “rejected” and deemed ineligible for processing.
Dr. Mwangangi stressed that the move is intended to tighten oversight and curb fraudulent billing practices within the public health financing system, which has been plagued by controversy in recent months.
Surveillance by County Health Teams
In addition to the digital reforms, SHA announced that routine surveillance activities will commence on Tuesday, September 16. County health teams will visit facilities to ensure compliance, and providers have been urged to cooperate fully.
To aid hospitals in adapting to the new system, SHA has published a step-by-step manual on its official portal.
